Contrast-enhanced ultrasound in monitoring the efficacy of a bradykinin receptor 2 antagonist in painful knee osteoarthritis compared with MRI

2008 ◽  
Vol 68 (1) ◽  
pp. 75-83 ◽  
Author(s):  
I H Song ◽  
C E Althoff ◽  
K G Hermann ◽  
A K Scheel ◽  
T Knetsch ◽  
...  
Keyword(s):  
Placebo Group ◽  
Knee Osteoarthritis ◽  
High Dose ◽  
Contrast Enhanced Ultrasound ◽  
Lateral Recess ◽  
Knee Oa ◽  
Bradykinin Receptor ◽  
Contrast Enhanced ◽  
Group B ◽  
Painful Knee

Objectives:To evaluate contrast-enhanced ultrasound (CE-US) as a monitoring tool to assess hypervascularisation of synovial processes in knee osteoarthritis (OA) treated with intra-articular injections of the bradykinin-receptor 2 antagonist icatibant compared to contrast-enhanced magnetic resonance imaging (CE-MRI).Patients and methods:In a randomised, double-blind, placebo-controlled trial, 41 patients with painful knee OA underwent US (12.5 MHz for B-mode and 3–8 MHz for CE-US), and 36 of the patients underwent additional MRI (0.2T) at baseline and after 3 injections of the study drug (after a mean of 22.2 days). A total of 15 patients received placebo (group A), 12 patients 500 μg icatibant (group B) and 14 patients 2000 μg icatibant (group C). Pain and the synovial process (B-mode, power Doppler US (PD-US), CE-US, CE-MRI) were assessed at both time points.Results:At baseline, the placebo group showed more activity in terms of effusion in the superior and lateral recess in ultrasound as well as in PD-US in the lateral recess. Pain improved significantly in all subgroups. Effect sizes were 0.43 (pain at rest) and 0.52 (pain during activity) in group B vs 0.48 and 1.11 in group C. There was no change of US and MRI parameters. We found moderate to good correlation (r) and kappa values (κ) for effusion in the superior recess (r = 0.591, k = 0.453), effusion in the lateral recess (r = 0.304, k = 0.440) and contrast enhancement (r = 0.601, k = 0.242) between US and MRI.Conclusions:Our results show that CE-US and CE-MRI have good agreement in assessing inflammatory changes in knee OA. For the 41 patients with OA, an analgesic effect of icatibant could clearly be shown, especially for pain during activity in the high dose icatibant group. However, we could not find an anti-inflammatory effect of icatibant by CE-US compared to CE-MRI.

THE EFFECT OF A TRIPOD CANE ON THE FUNCTIONAL MOBILITY OF PATIENTS WITH KNEE OSTEOARTHRITIS

2020 ◽  
Vol 5 (1) ◽  
pp. 29
Author(s):  
Nelson Sudiyono
Keyword(s):  
Knee Osteoarthritis ◽  
Cross Sectional Study ◽  
Functional Mobility ◽  
Cross Sectional ◽  
Knee Oa ◽  
Walking Aids ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Contralateral Hand ◽  
Painful Knee

Background: Canes have been recommended as walking aids for knee osteoarthritis to reduce the loading on the affected knee. Patients are usually recommended to hold the cane in the contralateral hand to the affected knee. Nevertheless, some patients prefer to hold the cane ipsilateral to the affected knee. However, the effect of using ipsilateral or contralateral tripod cane on functional mobility in patients with knee osteoarthritis is still unknown Objective: To compare the immediate effect of ipsilateral and contralateral tripod cane usage on functional mobility in patients with symptomatic knee osteoarthritis Method: This cross-sectional study involved 30 overweight or obese patients with symptomatic unilateral or bilateral knee osteoarthritis (Kellgren Lawrence grade 2 and 3) who never use a cane. Functional mobility was evaluated with Time Up and Go test in three conditions; without walking aid, with tripod cane contralateral and ipsilateral to the more painful knee. Results: The TUG time of aid-free walking is 4.75 (p < 0.001, 95% CI 3.79 - 5.71) seconds faster than ipsilateral cane use and 6.69 (p < 0.001, 95%CI 5.35 - 8.03) seconds faster than contralateral cane use. The TUG time of ipsilateral cane use is 1,94 (95% CI, 1.13 - 2.79) seconds faster than contralateral. Conclusion: Patients with symptomatic knee OA who use tripod cane ipsilateral to the more painful knee have higher functional mobility than the contralateral.

scholarly journals Cross-cultural adaptation, reliability and validity of the Fremantle Knee Awareness Questionnaire in Italian subjects with painful knee osteoarthritis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marco Monticone ◽  
Cristiano Sconza ◽  
Igor Portoghese ◽  
Tomohiko Nishigami ◽  
Benedict M. Wand ◽  
...  
Keyword(s):  
Construct Validity ◽  
Knee Osteoarthritis ◽  
Pain Intensity ◽  
Internal Consistency ◽  
Structural Validity ◽  
Retest Reliability ◽  
Knee Oa ◽  
Pain Catastrophising ◽  
Test Retest Reliability ◽  
Painful Knee

Abstract Background and aim Growing attention is being given to utilising physical function measures to better understand and manage knee osteoarthritis (OA). The Fremantle Knee Awareness Questionnaire (FreKAQ), a self-reported measure of body-perception specific to the knee, has never been validated in Italian patients. The aims of this study were to culturally adapt and validate the Italian version of the FreKAQ (FreKAQ-I), to allow for its use with Italian-speaking patients with painful knee OA. Methods The FreKAQ-I was developed by means of forward–backward translation, a final review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included: internal structural validity by Rasch analysis; construct validity by assessing hypotheses of FreKAQ correlations with the knee injury and osteoarthritis outcome score (KOOS), a pain intensity numerical rating scale (PI-NRS), the pain catastrophising scale (PCS), and the Hospital anxiety and depression score (HADS) (Pearson’s correlations); known-group validity by evaluating the ability of FreKAQ scores to discriminate between two groups of participants with different clinical profiles (Mann–Whitney U test); reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficient, ICC2.1); and measurement error by calculating the minimum detectable change (MDC). Results It took one month to develop a consensus-based version of the FreKAQ-I. The questionnaire was administered to 102 subjects with painful knee OA and was well accepted. Internal structural validity confirmed the substantial unidimensionality of the FreKAQ-I: variance explained was 53.3%, the unexplained variance in the first contrast showed an eigenvalue of 1.8, and no local dependence was detected. Construct validity was good as all of the hypotheses were met; correlations: KOOS (rho = 0.38–0.51), PI-NRS (rho = 0.35–0.37), PCS (rho = 0.47) and HADS (Anxiety rho = 0.36; Depression rho = 0.43). Regarding known-groups validity, FreKAQ scores were significantly different between groups of participants demonstrating high and low levels of pain intensity, pain catastrophising, anxiety, depression and the four KOOS subscales (p ≤ 0.004). Internal consistency was acceptable (α = 0.74) and test–retest reliability was excellent (ICC = 0.92, CI 0.87–0.94). The MDC95 was 5.22 scale points. Conclusion The FreKAQ-I is unidimensional, reliable and valid in Italian patients with painful knee OA. Its use is recommended for clinical and research purposes.

scholarly journals Dynamic contrast-enhanced MRI of synovitis in knee osteoarthritis: repeatability, discrimination and sensitivity to change in a prospective experimental study

2021 ◽  
Author(s):  
James W. MacKay ◽  
Faezeh Sanaei Nezhad ◽  
Tamam Rifai ◽  
Joshua D. Kaggie ◽  
Josephine H. Naish ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Experimental Medicine ◽  
Sensitivity To Change ◽  
Dce Mri ◽  
Dynamic Contrast Enhanced Mri ◽  
Knee Oa ◽  
Dynamic Contrast Enhanced ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Contrast Enhanced Mri

Abstract Objectives Evaluate test-retest repeatability, ability to discriminate between osteoarthritic and healthy participants, and sensitivity to change over 6 months, of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) biomarkers in knee OA. Methods Fourteen individuals aged 40–60 with mild-moderate knee OA and 6 age-matched healthy volunteers (HV) underwent DCE-MRI at 3 T at baseline, 1 month and 6 months. Voxelwise pharmacokinetic modelling of dynamic data was used to calculate DCE-MRI biomarkers including Ktrans and IAUC60. Median DCE-MRI biomarker values were extracted for each participant at each study visit. Synovial segmentation was performed using both manual and semiautomatic methods with calculation of an additional biomarker, the volume of enhancing pannus (VEP). Test-retest repeatability was assessed using intraclass correlation coefficients (ICC). Smallest detectable differences (SDDs) were calculated from test-retest data. Discrimination between OA and HV was assessed via calculation of between-group standardised mean differences (SMD). Responsiveness was assessed via the number of OA participants with changes greater than the SDD at 6 months. Results Ktrans demonstrated the best test-retest repeatability (Ktrans/IAUC60/VEP ICCs 0.90/0.84/0.40, SDDs as % of OA mean 33/71/76%), discrimination between OA and HV (SMDs 0.94/0.54/0.50) and responsiveness (5/1/1 out of 12 OA participants with 6-month change > SDD) when compared to IAUC60 and VEP. Biomarkers derived from semiautomatic segmentation outperformed those derived from manual segmentation across all domains. Conclusions Ktrans demonstrated the best repeatability, discrimination and sensitivity to change suggesting that it is the optimal DCE-MRI biomarker for use in experimental medicine studies. Key Points • Dynamic contrast-enhanced MRI (DCE-MRI) provides quantitative measures of synovitis in knee osteoarthritis which may permit early assessment of efficacy in experimental medicine studies. • This prospective observational study compared DCE-MRI biomarkers across domains relevant to experimental medicine: test-retest repeatability, discriminative validity and sensitivity to change. • The DCE-MRI biomarker Ktransdemonstrated the best performance across all three domains, suggesting that it is the optimal biomarker for use in future interventional studies.

scholarly journals Effect of Intra-articular Ketorolac Versus Corticosteroid Injection for Knee Osteoarthritis: A Retrospective Comparative Study

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091112
Author(s):  
Jianda Xu ◽  
Yuxing Qu ◽  
Huan Li ◽  
Aixiang Zhu ◽  
Tao Jiang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Knee Osteoarthritis ◽  
Sodium Hyaluronate ◽  
Knee Oa ◽  
Symptomatic Knee ◽  
Group A ◽  
Successful Outcomes ◽  
Group B ◽  
Corticosteroid Injections

Background: Intra-articular corticosteroid injections have been widely used and are considered a mainstay in the nonoperative treatment of symptomatic knee osteoarthritis (OA). However, their increased use can have negative implications, including chondral toxicity and a high risk of infections. As a result, nonsteroidal anti-inflammatory drugs have been considered as an alternative. Purpose: To determine the pain relief and safety of ketorolac versus a corticosteroid to supplement an intra-articular sodium hyaluronate injection for the treatment of symptomatic knee OA. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 patients with unilateral symptomatic knee OA receiving 5 weekly injections were enrolled in this retrospective study. Group A (n = 42) received 3 weekly intra-articular corticosteroid injections (0.5% lidocaine, 25 mg of triamcinolone acetonide, and 25 mg of sodium hyaluronate, followed by 2 weekly injections of 0.5% lidocaine and 25 mg of sodium hyaluronate), while group B (n = 42) received 5 weekly ketorolac injections (0.5% lidocaine, 10 mg of ketorolac, and 25 mg of sodium hyaluronate). The following parameters were used to evaluate pain relief and safety: visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and side effects before the injection and at 1, 2, and 5 weeks after treatment commencement as well as 3 months after the last injection. Results: Patients from both groups had a significant improvement in VAS and WOMAC scores from the first injection to final follow-up at 3 months. In the first week, the VAS score was lower in group A ( P = .041), but no significant between-group differences were found for either the VAS or the WOMAC score at the other time points. Of the 42 patients in group A, 34 (81.0%) and 25 (59.5%) achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. In group B, 32 (76.2%) and 24 (57.1%) patients achieved successful outcomes at 5 weeks after treatment commencement and 3 months after the last injection, respectively. At final follow-up, no significant difference was found in the successful treatment rate between the groups ( P = .825). Conclusion: The current study demonstrated that intra-articular ketorolac and corticosteroid injections produce the same pain relief and functional improvement.

scholarly journals Pharmaceutical-grade Chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT)

2017 ◽  
Vol 76 (9) ◽  
pp. 1537-1543 ◽  
Author(s):  
Jean-Yves Reginster ◽  
Jean Dudler ◽  
Tomasz Blicharski ◽  
Karel Pavelka
Keyword(s):  
Placebo Group ◽  
Knee Osteoarthritis ◽  
Chondroitin Sulfate ◽  
Controlled Trial ◽  
European Medicines Agency ◽  
Double Blind ◽  
Knee Oa ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Secondary Endpoints

ObjectivesChondroitin sulfate 800 mg/day (CS) pharmaceutical-grade in the management of symptomatic knee osteoarthritis consistent with the European Medicines Agency guideline.MethodsA prospective, randomised, 6-month, 3-arm, double-blind, double-dummy, placebo and celecoxib (200 mg/day)-controlled trial assessing changes in pain on a Visual Analogue Scale (VAS) and in the Lequesne Index (LI) as coprimary endpoints. Minimal-Clinically Important Improvement (MCII), Patient-Acceptable Symptoms State (PASS) were used as secondary endpoints.Results604 patients (knee osteoarthritis) diagnosed according to American College of Rheumalogy (ACR) criteria, recruited in five European countries and followed for 182 days. CS and celecoxib showed a greater significant reduction in pain and LI than placebo. In the intention-to-treat (ITT) population, pain reduction in VAS at day 182 in the CS group (−42.6 mm) and in celecoxib group (−39.5 mm) was significantly greater than the placebo group (−33.3 mm) (p=0.001 for CS and p=0.009 for celecoxib), while no difference observed between CS and celecoxib. Similar trend for the LI, as reduction in this metric in the CS group (−4.7) and celecoxib group (−4.6) was significantly greater than the placebo group (−3.7) (p=0.023 for CS and p=0.015 for celecoxib), no difference was observed between CS and celecoxib. Both secondary endpoints (MCII and PASS) at day 182 improved significantly in the CS and celecoxib groups. All treatments demonstrated excellent safety profiles.ConclusionA 800 mg/day pharmaceutical-grade CS is superior to placebo and similar to celecoxib in reducing pain and improving function over 6 months in symptomatic knee osteoarthritis (OA) patients. This formulation of CS should be considered a first-line treatment in the medical management of knee OA.

scholarly journals K-Means Clustering Algorithm-Based Detection of Carotid Atherosclerotic Plaque Using Contrast-Enhanced Ultrasound Images

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Ruitao Zhou ◽  
Ruijie Zhou ◽  
Zhibo Zhu
Keyword(s):  
Atherosclerotic Plaque ◽  
Clustering Algorithm ◽  
Detection Method ◽  
Control Group ◽  
Carotid Atherosclerotic Plaque ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Group A ◽  
Group B ◽  
Sensitivity Specificity

The aim of this study was to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) based on the K-means clustering (KMC) algorithm for the vulnerability of carotid atherosclerotic plaque (CAA). In this study, 90 patients with CAA were enrolled into a control group (group A) and an experimental group (group B). The angiography method and KMC-based ultrasound detection were applied to diagnose the CAA patients from the two groups, respectively. The results showed that the sensitivity, specificity, and positive predictive value of patients from group B (92.3%, 90.1%, and 94.8%) for diagnosing CAA were obviously higher than those of patients from group A (81.4%, 88.6%, and 75.3%) ( P < 0.05 ). The detection rate of patients from group B (83%, 85%) was dramatically higher than that of patients from group A (65%, 71%) in terms of artery bifurcation and CAA ( P < 0.05 ). Besides, patients from group B were more satisfied with their diagnostic method than group A ( P < 0.05 ). In conclusion, the ultrasound detection method based on KMC had high sensitivity, specificity, and accuracy in the detection of CAA. In addition, ultrasound detection was better than angiography in the diagnosis of plaque in different parts, and it was worthwhile to apply the ultrasound detection method based on KMC in clinical practice.

scholarly journals T2 mapping evaluation of changes in cartilage matrix after PRP and HA injection therapy in knee osteoarthritis: a prospective, randomized, double blind, placebo controlled study

2020 ◽  
Author(s):  
Matjaz Vogrin ◽  
Jakob Naranda ◽  
Mario Gorenjak ◽  
Tomaz Bajec ◽  
Domen Mongus ◽  
...  
Keyword(s):  
Placebo Group ◽  
Knee Osteoarthritis ◽  
Pain Score ◽  
T2 Mapping ◽  
Womac Score ◽  
Controlled Study ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Knee Oa

Abstract BackgroundIn this study we focused on evaluating the effect of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) on the qualitative and quantitative properties of the articular cartilage in patients with knee osteoarthritis (OA).MethodsWe evaluated 264 patients undergoing treatment of moderate knee OA. Patients aged between 40 and 70 years were included with articular K-L stage ≤ 2. Patients were randomized into three groups and treated with three doses of intra-articular PRP, HA, or placebo injection. Patients were evaluated clinically and by using T2 mapping.ResultsBoth PRP (619.05 ± 243 ms; p = 2.7 × 10− 5) and HA (637.12 ± 273 ms; p = 1.×10− 4) group showed statistically significant lower post-application T2 relaxation times in comparison to the placebo group (859.80 ± 406 ms).Cartilage thickness increased significantly after PRP (2.41±0.87 vs. 2.58±0.97 mm, p=0.033) and HA (2.28±0.81 vs. 2.80±1.00 mm, p=1.8×10) applications. There was a significant decrease in WOMAC pain score by 30% (p=0,001) and the overall WOMAC score by 27 p=1.9×10-4%) in PRP group. The decrease in WOMAC pain score and the overall WOMAC score in the placebo group was similar to the results observed in the PRP group. In the HA group a significant decrease in WOMAC pain score by 14% (p=0,005) was observed only at the first follow-up, whereas no difference was observed at the second follow-up. ConclusionsT2 mapping of cartilage tissue may aid to monitor its properties after the intra-articular therapies in knee OA. However, there is a discrepancy between clinical findings and the results of T2 mapping, suggesting questionable grounds for applying intra-articular therapy.

scholarly journals Comparison Of Diacerein-Ginger With Diacerein Alone In Treating Knee Osteoarthritis

2019 ◽  
Vol 09 (04) ◽  
pp. 308-311
Author(s):  
Mehtab Munir ◽  
Shahid Mustafa Memon ◽  
Sajid Abbas Jaffri ◽  
Khalid Mustafa Memon
Keyword(s):  
Knee Osteoarthritis ◽  
P Value ◽  
Womac Pain ◽  
Test Results ◽  
Knee Oa ◽  
Significant Difference ◽  
Group A ◽  
Insignificant Difference ◽  
Group B ◽  
Pain At Rest

Objective: To compare clinical efficacy of diacerein-ginger with diacerein alone in treating knee osteoarthritis. Duration and place of study: It was a randomized clinical trial conducted from 21st September 2018 to 31stMarch 2019, in medical OPD of a private hospital in Karachi. Methodology: 60 diagnosed patients of knee osteoarthritis were included in this study. Male and female patients 50 years of age, fulfilling the inclusion criteria and after written informed consent experienced a wash-out period of 72 hours. These patients were systematically randomized into 2 groups each having 30 members. Group A received capsule Diacerein 50mg + capsule Ginger 550 mg twice daily and group B received capsule Diacerein 50mg twice daily, for 12 weeks. Parameters checked at 0, 6 and 12 weeks were: Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, pain at rest and movement (Visual Analogue Scale). Comparison of the two groups was done by independent t-test. Results: Among 60 patients; 20 (33.33 %) were males and 40 (66.66%) were females. 4 patients in group A and 4 in B, dropped out during the study. Comparison of group A with group B in WOMAC and pain (at rest and movement) scores showed insignificant difference at day 0 before prescription of the drugs. However comparison showed highly significant difference (P-value < 0.001) between the two groups in WOMAC, pain at rest and movement scores at the end of 6th and 12th weeks of intervention. Conclusion: Diacerein-Ginger is clinically more efficacious for management of knee OA than Diacerein alone

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